Plenary 1: The Hospital – A Staff Empowering ... - HPH-Conference

Contact
Dr. Lai Fong Chiu
Institute of Health Sciences
University of Leeds
71-75 Clarendon Road,
LS2 9PL Leeds
UK-ENGLAND
+44 113 343 69 08
l.f.m.chiu@leeds.ac.uk
http://www.leeds.ac.uk/hsphr/hsc
Parallel Sessions
Parallel Sessions 1: Thursday, April 12, 2007, 11.00-12.30
Emergency service Hospital del Mar,
Barcelona: Are there differences between
immigrant and non immigrant
residents in use, complexity and
costs?
Cristina Iniesta Blasco, Francesco Cots Reguant,
Xavier Castells Oliveras, Andrea
Burón Pust, Ana Sancho Gómez de Travesedo,
Oriol Vall Combelles, Oscar García
Algar
Several studies support the idea that immigrants make greater
use of emergency services than of other healthcare facilities.
The reasons for this phenomenon are diverse. Firstly, emergency
care in Spain is public, free and universal, independently
of nationality and length of residence. In addition, primary and
specialised care presents several barriers to immigrants
without papers. In 2005, the immigrant population was 38.5%
of the district of Ciutat Vella, which is within the catchment
area of Hospital del Mar (Barcelona).
The aim of this study was to compare the emergency department
utilization rates between immigrants and Spanish-born
residents in Ciutat Vella. Emergency contacts during 2004
were provided by the emergency room register of the Hospital
del Mar.
A multivariate linear mixed model of direct costs was adjusted
by country of origin (classified in five groups) and by the individual
variables of age, gender, hospital admission, and death
as a cause of discharge. Medical specialty was considered as
a random effect.
Results
The overall utilization rate in the studied area was 391 emergency
contacts per 1,000 person years. Foreign-born persons
had 7% smaller crude utilization rates than those born in Spain,
and 15% lower after adjusting for age, gender and emergency
department. In the emergency gynaecology department immigrants
utilization rate was higher and in the rest of departments
smaller than that of Spanish-born people, after adjusting
for age and gender: utilization rate ratio of immigrants against
Spanish-born in surgery 0.75 (95% IC 0.60; 0.92); orthopaedics
0.66 (0.51; 0.86); medicine 0.77 (0.62; 0.96); paediatrics
0.73 (0.64; 0.81); gynaecology and obstetrics 2.00
(1.11; 3.59).
With the exception of gynaecological emergency visits, costs
resulting from emergency visits by both groups of immigrants
were lower than those due to visits by the Spanish-born population.
This effect was especially marked for emergency visits by
adults.
Conclusion
Immigrants tend to use the emergency immigrant and non
immigrant department in preference to other health services.
No differences were found between immigrant and non immigrant,
suggesting that this result was due to the ease of access
to emergency services and to lack of knowledge about
the country’s health system rather than to poor health status
resulting from immigrants’ socioeconomic position. The differences
found in the emergency room utilization rates between
Spanish-born and immigrants are probably due to the healthy
immigrant effect and suggest a lower impact on healthcare
services than was probably expected. These findings should be
related to the conclusions of studies on access barriers to
other health services. The high utilization rate of immigrant
women in the gynaecology and obstetrics emergency department
would request interventions to promote the use of primary
healthcare services during pregnancy.
Contact
Dr. Cristina INIESTA BLASCO
Director Hospital
Hospital del Mar
Passeig Marítim, 25-29
08003 Barcelona
SPAIN
+34 932 483 273
ciniesta@imas.imim.es
Mum Health: A programme for the
promotion of global health of migrant
women in Tuscany, Italy
Manila Bonciani, Elisabetta Confaloni, Benedetta
Cangioli
The Tuscany Region’s Mum Health programme has been set up
in response to the ever-increasing numbers of migrant women
in Italy and in Tuscany and the need to safeguard women’s
health, particularly their reproductive health. According to
national research, many social and linguistic barriers obstruct
migrant women’s access to and taking advantage of sociomedical
services, thus causing a risk for migrant women in
terms of inadequate assistance in pregnancy, insufficient
neonatal care, incorrect use of contraception and greater
recourse to abortion.
The final aim of the Mum Health programme is to promote and
improve the health, taken to mean the “global health”, of migrant
women living in Tuscany, with the rebound impact that
this has on the well-being of migrant children and communities,
given women’s pivotal role as care givers.
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